Substance Abuse Disorders Flashcards
Define ADDICTION
Addiction: a cluster of cognitive, behavioral and physiologic signs that indicate compulsive use of a substance and inability to control intake despite negative consequences (medical illness, failure in life roles, interpersonal difficulties)
Define DEPENDENCE
upon cessation of drug, an individual experiences pathological signs and symptom (tolerance and withdrawal)
Define TOLERANCE
requiring a markedly increased dose of the substance to achieve the desired effect, or a markedly reduced effect when the usual dose is consumed
Define WITHDRAWAL
a drug specific syndrome that occurs when blood or tissue concentrations of a substance decline in someone who has maintained prolonged heavy use.
Epidemiology of addiction
- about 9% of adolescents, aged 12-17 are classified as needing treatment for alcohol and substance abuse
- greater use in adolescence translates into greater use as an adult (the earlier you start, the more likely it is to persist into later life)
- gay, lesbian and bisexual youth report for SUDS use than heterosexual youth
- females more likely than males among GLB youth to use and males more than females among heterosexual youth
Frequency of addiction
- 10-20% of population at some point
- app 10% with substance dependence (including alcohol) commit suicide ( most often int he context of a mood disorder)
- estimated 22 million in 2002 classified with substance dependence or abuse (9.4 percent of total population aged 12 and older)
- 3.2 mil classified with dependence or abuse of both alc and drugs
- 3.9 dependent on abused illicit drugs but not alcohol
14. 9 mil dependent on or abused alcohol but not illicit drugs
Most frequently abused drugs
- marijuana the most commonly used illicit drug with a rate of 6.9 %(17.4 mil)
- cocaine: 1.5 mil (0.6%)- 25% used crack
- hallucinogens: 1.2 mil (0.5%) over half of whom used Ecstasy
- 166,000 current heroin users
- abused psychotherapeutic drugs: 7 million (2.7%)
Influence of early drug/alcohol use
- dramatic relationship between age of first drug use and subsequent drug abuse/dependence
- early first use 13 y/ or younger will triple the odds of drug dependence in adulthood
- strongest predictor of drug use is prior drug use
- dramatic relationship between age of first alcohol use and subsequent alcohol abuse / dependence
- early first use (15 y/o or younger) will increase the rate of subsequent alcohol abuse/dependence by 6 fold compared to those who tried it 21 or older
- each year drinking onset is delayed, risk of alcohol dependence is reduced by 14%
CONCLUSION: if risk factors discovered and treated early and drug initiation delayed–> adolescent SUDS can be prevented!
the “gateway” concept
- if starting on marijuana, gateway to be addicted to both cigarettes and alcohol (59.5%) or one or the other
Risk Factors
Family and peers
- chaotic home environments especially parental
- substance use and mental illness
- lack of parental monitoring or involvement especially with kids with difficult temperaments and conduct disorders
- parental permissiveness
- lack of mutual attachments and nurturing
- use by siblings
- verbal, physical, emotional abuse
- peer substance use
- affiliation with deviant peer group
Environmental/Cultural
- perceptions of approval of drug using behaviors in school, peer, and community environments
- drug availability
- trafficking patterns
- urban settings
- homelessness
- low socioeconomic status
- media promotion of use
- negative attitude toward use
- community codependency and secrecy
Life events:
- school/ academic failure
- poor social coping skills
- abuse or neglect
- exposure to violence
- victimization by assault
Protective Factors
- strong bonds with family
- parental monitoring
- clear rules of conduct within the family
- involvement of parents in children’s lives
- success in school performance
- strong bonds with pro-social institution (family, school, religions organizations or spiritual practice)
- exposure to use prevention programs
- adoption of conventional norms about drug abuse
The role of education in drug abuse/ addiction
Education is also associated with drug abuse
illicit drug use is lower for college graduates than those who do not graduate from high school, high school graduates and those with some college
- by contrast, college graduates are more likely to try illicit drugs in their lifetime than adults who have not completed high school
Dopamine theory of addiction
they want to increase their dopamine (DA) in the limbic circuit (nucleus accumbens)
DA is a neurotransmitter that helps to regulate motivation of behaviors necessary for survival
- food intake, sexual behavior, social interaction, and drugs of abuse increases DA
- increase of DA is crucial to their reinforcing/addictive affects
- DA cells turn our attention to what is salient (fun, sad, important for survival, aversive, etc)
- so if the D2 intensity is increased in drug users, they will then experience less of a “signal” from the firing of DA neurons in a given situation or…
- natural reinforces ( like food sex getting and a on an exam) are less rewarding than they would be otherwise because changes in DA are not large enough to signal them as salient stimuli
- increases in DA in the synapse are 5-10x greater with drugs than with natural reinfocers
- moreover, drugs like cocaine, amphetamine, and methamphetamine block the reuptake transporter, so DA stays in the synapse longer than with natural reinfocers
- thus, despite the fact tat the number of receptors is decreased in drug abusers, the probability of interaction between DA and receptors is very large, not only because the DA concentration is very high but because it stays in the synapse longer
- so the drug abuser learns that while natural reinforcers are no longer able to produce a salient “feel good” signal, drugs of abuse do , this fact drives and motivates subsequent behavior
Negative health effects of alcohol
- dehydration
- addiction
- accidents and injury
- depression and psychosis
- ulcers
- cancer of mouth/throat/stomach
- cirrhosis
- brain damage
- pancreatic damage
- decreased fertility
- fetal alcohol syndrome
- high blood pressure
- increase risk of breast cancer
Warning signs of drug and alcohol abuse
- changes in school performance ( falling grades, skipping school, tardiness)
- changes in peer group ( hanging ouw ith drug using, antisocial, older friends)
- breaking rules (home, school, community)
- affect changes (mood swings, depression, irritability, anger, negative attitude)
- activity level: sudden increases or decreases
- withdrawal from family, secretiveness
- changes in physical appearance ( weight loss, lack of cleanliness, strange smells)
- eyes: red, watery, glassy
- nose: runny and not due to allergies or cold
- eating;sleeping habits change
- decreased motivation in pleasure teen actiities
- antisocial behavior: lying or stealing
- using street or drug language
- possession of drug paraphernalia
- cigarette smoking
- initiation of drug use before 12 or 13
- daily or weeks use of at least one drug
- poly drug use
